health expectancy to monitor health: achievements and challenges ahead in the netherlands
DESCRIPTION
Health expectancy to monitor health: Achievements and challenges ahead in the Netherlands. Wilma Nusselder Department of Public Health Erasmus MC Rotterdam, The Netherlands [email protected] Task force on Health Expectancy, Luxembourg, June 8, 2006. History of HE in the Netherlands. - PowerPoint PPT PresentationTRANSCRIPT
Health expectancy to monitor health: Achievements and challenges ahead in the
Netherlands
Wilma Nusselder
Department of Public Health
Erasmus MC
Rotterdam, The Netherlands
Task force on Health Expectancy, Luxembourg, June 8, 2006
History of HE in the Netherlands
• Mortality measures to monitor population health have important
limitations
• Development of health expectancy (HE) measures
• Netherlands among the first countries to use health expectancy
measures- Van Ginneken, 1988/89
• More than 15 years experience with HE in the Netherlands
Use of HE in the Netherlands
HE is multi-purpose measure:
1. Description of health of the Dutch population
2. Description of disparities within the Dutch population
3. Monitoring differences in population health over time
4. Explaining differences between subgroups, or over time
5. Assessing health targets
1. Description of health of the Dutch population, 2003
Source : National Institute for Public Health and the Environment
Men, yrs Women, yrs
Total life expectancy (LE) 76.3 80.9
LE in good health 62.2 61.1
LE free of disability 69.9 68.8
LE in good mental health 69.1 69.3
2. Description of disparities within the population (a)
DFLE by SES
Source : National Institute for Public Health and the Environment
2. Description of disparities within the population (b)
DFLE by region
Source : National Institute for Public Health and the Environment
3. Monitoring differences in population health over time
LE in good health
Source : National Institute for Public Health and the Environment
4. Explaining differences between subgroups (a)
Gender gap in LE with disability (1990-1994):
Men: 8.4 yrs
Women 14.8 yrs
Difference: 6.4 yrs
Why is number of years with disability higher among women?
Decomposition analysis
5. Assessing health targets
Policy targets formulated in terms of HE:
• Objective:
• To decrease the 12-year difference in HE between SES-groups, by
increasing the HE of persons with a low SES from 53 years to 56
years in the period 2000 to 2020
Source: Preventieve Gezondheidszorg. Tweede Kamer, vergaderjaar
2003-2004 29300, nrs.1-2
HE: also limitations in studying trends
Shift from mortality to health has made it all a matter of definition and measurement
1. Health expectancy sensitive to change or chance?
2. Health expectancy trend dependent on exact definition
3. Data are relatively weak
4. Unclear which measure should be used in what situation
1. HE sensitive to change or chance?
DFLE
Source : National Institute for Public Health and the Environment
2. HE trend dependent on exact definition (a)
DFLE women
48
53
58
63
68
73
1989
1991
1993
1995
1997
1999
DFLE (Nat Institute) DFLE AMC
2. HE trend dependent on exact definition (b)
Website National Institute for Public Health and the Environment:
“Korte tijd stijging van levens-
verwachting zonder beperkingen”
1990-2000: DFLE increases
Press release AMC:
“Gezonde levensverwachting daalt.
Het aantal te verwachten levensjaren
zonder beperking is in ons land
afgenomen”
1990-2000: DFLE decreases
2. HE trend dependent on exact definition (c)
Bron: EHEMU, 2005
DFLE at birth, men
50
60
70
80
1995
1996
1997
1998
1999
2000
2001
2002
2003
Austria
Belgium
Denmark
Finland
France
Germany
Greece
Ireland
Italy
Netherlands
Portugal
Spain
Sweden
United Kingdom
2. HE trend dependent on exact definition (d)
Bron: EHEMU, 2005
DFLE at birth, women
50
60
70
80
1 2 3 4 5 6 7 8 9
Austria
Belgium
Denmark
Finland
France
Germany
Greece
Ireland
Italy
Netherlands
Portugal
Spain
Sweden
United Kingdom
3. Data are relatively weak
Official calculations of HE in Netherlands:
• Response rate < 60%
• Self-reported health measures
• Sample among non-institutionalized population
• Small number of elderly included (85+)
• 1994: n= 8823
58 persons in age group 85+
208 persons in age group 80+
Small sample size among the elderly
1991-1993; 1996-1998; 2000-2003
85+: 1990-1992 in stead of 1991-1993
Women
0
10
20
30
40
50
1990 1992 1994 1996 1998 2000 2002
65-74
75-84
85+
P65-74
P75-84
P85+
women, % ADL
0
5
10
15
20
25
30
1 2 3
P65-74
P75-84
P85+
women, % ADL
0
5
10
15
20
25
30
1 2 3
P65-74
P75-84
P85+-alt
Women
0
10
20
30
40
50
1990 1992 1994 1996 1998 2000 2002
4. Unclear which measure to be used in what situation
Monitoring:
• Confusion about trends in DFLE
Target setting:
• Government uses for target setting HE in good health
• Based on self-perceived health
Conclusion
HE has important added values as compared to health measures based on mortality
This added value has become clear in the Netherlands, where HE has become multi-purpose measure
But Dutch experience has also pointed at limitations
Challenges for the future
• Better data
• Better measures?
• Better techniques to assess changes over time?
• Better guidance to policy makers which indicator to use
Thank you for your attention